Effect of hormonal contraceptives on the ocular surface and the tear film


Muhammad Syauqie(1*)

(1) Department of Ophthalmology, Faculty of Medicine, Andalas University, Padang, West Sumatra, Indonesia
(*) Corresponding Author


Dry eye syndrome (DES) is a common multifactorial disease of the tears andocular surface associated with sex hormones. Hormonal contraception is arisk factor for DES, but its relationship with DES exacerbations in womenof childbearing age is still unclear. This study aimed to evaluate changesof the tear film and ocular surface of young women using the hormonalcontraceptive agent. It was a case-control study involving 56 healthywomen aged 20 to 45 y.o. Subjects was divided into two groups i.e. thehormonal contraceptives group and the control group without hormonalcontraceptive. Subjects were interviewed with the ocular surface diseaseindex (OSDI) questionnaire. Tear secretion and tear stability were measuredusing Schirmer’s I test and fluorescein tear break-up time test (TBUT).Ocular surface impression cytology with cellulose acetate filter paper wastaken from inferonasal bulbar conjunctiva and was stained with periodicacid- Schiff (PAS) and counterstained with hematoxylin and eosin (HE). Nosignificantly decrease in tear secretion and tear stability in the hormonalcontraceptives group compared with the control groups was observed (p >0.05). However, a statistically significant decrease in goblet cell density andconjunctival epithelium metaplasia was observed, where 25% of the hormonalcontraceptives group had an abnormal impression cytology result comparedwith the control group (p<0.05). The hormonal contraceptives group also hada higher OSDI score than the control group, although it was not statisticallysignificant (p> 0.05). The hormonal contraceptives group had a signifificanteffect on the ocular surface in which it induced squamous metaplasia andinflflammation of conjunctival cells and the reduced number of goblet cellsp<0.05). The slightly decreased tear film volume and stability accompaniedby an increase in OSDI score found in the hormonal contraceptives groupsupport the possibility of hormonal contraceptive use as one of the riskfactors in the occurrence of dry eye syndrome.


hormonal contraceptives; tear secretion and stability; sex hormones; impression cytology; dry eye

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Stapleton F, Alves M, Bunya VY, Jalbert I, Lekhanont K, Malet F, et al. TFOS DEWS II epidemiology report. Ocul Surf 2017; 15(3):334-65.
2.Sullivan DA, Rocha EM, Aragona P, Clayton JA, Ding J, Golebiowski B, et al. TFOS DEWS II sex, gender, and hormones report. Ocul Surf 2017; 15(3):284-333.
3.Sharma A, Porwal S, Tyagi M. Effect of oral contraceptives on tear film in reproductive age group women. IJRCOG 2018; 7(3):860-3.
4.Versura P, Fresina M, Campos EC. Ocular surface changes over the menstrual cycle in women with and without dry eye. Gynecol Endocrinol 2007; 23(7):385-90.
5.Sullivan DA. Tearful relationships? Sex, hormones, the lacrimal gland, and aqueous-deficient dry eye. Ocul Surf 2004; 2(2):92-123.
6.Tomlinson A, Pearce EI, Simmons PA, Blades K. Effect of oral contraceptives on tear physiology. Ophthalmic Physiol Opt 2001; 21(1):9-16.
7.He B, Iovieno A, Etminan M, Kezouh A, Yeung SN. Effects of hormonal contraceptives on dry eye disease: a population-based study. Eye 2022; 36(6):634-8.
8.Frankel SH, Ellis PP. Effect of oral contraceptives on tear production. Ann Ophthalmol 1978; 10(11):1585-8.
9.Chen SP, Massaro-Giordano G, Pistilli M, Schreiber CA, Bunya VY. Tear osmolarity and dry eye symptoms in women using oral contraception and contact lenses. Cornea 2013; 32(4):423-8.
10.Kemdinum Idu F, Osita Emina M, Oyem Ubaru C. Tear secretion and tear stability of women on hormonal contraceptives. J Optom 2013; 6(1):45-50.
11.Brennan NA, Efron N. Symptomatology of HEMA contact lens wear. Optom Vis Sci 1989; 66(12):834-8.
12.Saif MYS, Sayed MAEG, Saif ATS. Effect of hormonal contraception on lacrimal gland function. Int J Ophthalmol 2016; 7(7):1207-11.
13.Hagan S. Biomarkers of ocular surface disease using impression cytology. Biomark Med 2017; 11(12):1135-47.
14.Singh R, Joseph A, Umapathy T, Tint NL, Dua HS. Impression cytology of the ocular surface. Br J Ophthalmol 2005; 89(12):1655-9.
15.Schiffman RM, Christianson MD, Jacobsen G, Hirsch JD, Reis BL. Reliability and validity of the ocular surface disease index. Arch Ophthalmol 2000; 118(5):615-21.
16.Tseng SC. Staging of conjunctival squamous metaplasia by impression cytology. Ophthalmology 1985; 92(6):728-33.
17.Truong S, Cole N, Stapleton F, Golebiowski B. Sex hormones and the dry eye. Clin Exp Optom 2014; 97(4):324-36.
18.Clark MK, Sowers M, Levy BT, Tenhundfeld P. Magnitude and variability of sequential estradiol and progesterone concentrations in women using depot medroxyprogesterone acetate for contraception. Fertil Steril 2001; 75(5):871-7.
19.Murube J, Rivas L. Impression cytology on conjunctiva and cornea in dry eye patients establishes a correlation between squamous metaplasia and dry eye clinical severity. Eur J Ophthalmol 2003; 13(2):115-27.
20.Shrestha E, Shrestha JK, Shayami G, Chaudhary M. The conjunctival impression cytology between the diagnosed cases of dry eye and normal individuals. Nepal J Ophthalmol 2011; 3(1):39-44.
21.Tyagi M, Khare P, Sharma A. Dry eye syndrome in reproductive age group women on oral contraceptives. Indian J Clin Exp Ophthalmol 2018; 4(2):263-7.
22.Kovalevsky G, Ballagh SA, Stanczyk FZ, Lee J, Cooper J, Archer DF. Levonorgestrel effects on serum androgens, sex hormone-binding globulin levels, hair shaft diameter, and sexual function. Fertil Steril 2010; 93(6):1997-2003.
23.Zimmerman Y, Eijkemans MJC, Coelingh Bennink HJT, Blankenstein MA, Fauser BCJM. The effect of combined oral contraception on testosterone levels in healthy women: a systematic review and meta-analysis. Hum Reprod Update 2014; 20(1):76-105.
24.Pult H, Purslow C, Murphy PJ. The relationship between clinical signs and dry eye symptoms. Eye 2011; 25(4):502-10.
25.Lee JH, Kim CH, Choe CM, Choi TH. Correlation analysis between ocular surface parameters with subjective symptom severity in dry eye disease. Korean J Ophthalmol 2020; 34(3):203-9.
26.Amparo F, Dana R. Is the ocular surface disease index (OSDI©) the right tool to measure patient perception of ocular surface symptoms? Invest Ophthalmol Vis Sci 2017; 58(8):2654.
27.Amparo F, Schaumberg DA, Dana R. Comparison of two questionnaires for dry eye symptom assessment: the ocular surface disease index and the symptom assessment in dry eye. Ophthalmology 2015; 122(7):1498-503.
28.Garhöfer G, Santos VAD, Stegmann H, Schmidl D, Adzhemian N, Werkmeister RM, et al. The Association between tear film thickness as measured with OCT and symptoms and signs of dry eye disease: a pooled analysis of 6 clinical trials. J Clin Med 2020; 9(11):3791.
29.Song H, Zhang M, Hu X, Li K, Jiang X, Liu Y, et al. Correlation analysis of ocular symptoms and signs in patients with dry eye. J Ophthalmol 2017; 2017:1247138.

DOI: https://doi.org/10.19106/JMedSci005404202205

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Journal of the Medical Sciences (Berkala Ilmu Kedokteran) by  Universitas Gadjah Mada is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
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